VA’s progress on treating cancer since 2016

Every year, VA diagnoses and treats about 43,000 Veterans with new cases of cancer; VA currently treats 400,000 Veterans with cancer. Here is VA’s progress on treating cancer.

Treatment and screening

VA launched the National Precision Oncology Program that allows us to target treatments to the right patients at the right time through a molecular understanding of the patient’s tumor. In 2016, we started with a handful of sites that were able to collect and test samples. Since then, we expanded to 129 sites, providing 24,000 molecular tests to 18,000 Veterans.

The growth of the program was especially important with access for Veterans because, in the general population, these therapies are not usually reimbursed, are expensive, and are not widely available.

VA also started the National TeleOncology Service to provide all Veterans with sub-specialized cancer care, especially those in remote areas where there is not an oncologist. This expansion and ability to provide cancer care virtually has also allowed us to treat Veterans equitably.

In our partnership with the National Cancer Institute and the program NAVIGATE, (National Cancer Institute and VA Interagency Group to Accelerate Trials Enrollment) we were able to increase Veteran access to novel National Cancer Institute cutting-edge clinical trials at 12 sites within VA. There has been an emphasis on enrollment of underrepresented Veterans in clinical trials. The benefit to Veterans is the ability to access more therapeutic options to potentially extend and improve the quality of their lives.

Testing

In the expansion on NPOP we were able to provide our Veterans access to germline genetic testing at more than 85 of our medical centers. This testing allows Veterans to guide their own treatment as well as inform the Veterans’ family members about their inherited genetic mutations, which may predispose family members to certain cancers. This information may be used to steer the Veterans’ family members to more timely screening, diagnosis and treatment for cancers they may be predisposed to.

Research

We partnered with DoD and NIH’s National Cancer Institute in the development of Applied Proteogenomics Organizational Learning and Outcomes (APOLLO) Program. APOLLO and Proteogenomics address the unique findings and features of service members’ and Veterans’ tumors by studying protein-based cancer biomarkers, its alterations and mutations, and applying this knowledge to the precise treatment of our Veterans and service members.

Rare cancers and unique exposures

About 16% of all cancers in VA are rare cancers, and the effect of Veterans’ unique exposures is not well understood. A few examples include gynecological cancers and B-Cell hematological malignancies.

To address this, we are establishing a new program aimed at targeting Veterans’ rare cancers and will partner with and expand upon existing DoD and other federal agency partnerships to implement this program. The VA Rare Cancer Program will combat rare cancers through a multi-pronged approach using sub-specialized oncologists, clinical pathways, advanced testing and research. The potential impact for Veterans includes rapid diagnosis, access to advanced precision treatments and clinical trials, and proficient management of disease to reduce inequities in care. Further, this effort provides research opportunities to close the knowledge gap in genetic and molecular understanding of rare cancers that can affect patient care, drug development and disparities in disproportionately affected populations.

To help us understand the contribution of the exposure to a cancer diagnosis, VA, CDC, DoD, NCI, National Institute of Environmental Health Sciences (NIEHS), EPA and HHS will develop a cohort of Veteran tumor samples from various registries to conduct sequencing of tumor samples and identify genomic signatures that may be associated with carcinogens from military and environmental exposures. This approach has been attempted in the past, but because of privacy constraints, there was a lack of progress. The collaboration would be beneficial in the interpretation of the data for cancers specific to military service members.

We will develop a centralized and accessible data compilation to better understand Veterans’ unique exposures and to ensure two-way data exchange. Currently, the VA Cancer Registry System expends substantial effort to identify and track incident cancer cases throughout VA, and we are limited in functionality to automate integration of all relevant cancer-related data. With this data made accessible in this way, VA, other agencies and institutions would have the ability to learn from more patients and reduce the cost and time of data curation.

Cancer screening efforts

As a result of the pandemic, many Veterans and civilians have deferred cancer screenings. Additionally, a quarter of all Veterans live in rural locations, making access to screening more difficult. Lung cancer is the second most common form of cancer for our Veterans, where nearly 8,000 are diagnosed with lung cancer. Lung cancer is also the deadliest form of cancer among Veterans, where 5,000 Veterans die annually. Deferred cancer screening prevents diagnosis and timely treatment. VA has been focusing on promoting cancer screening for breast, colorectal, lung, cervical and prostate cancers to encourage Veterans to address pandemic-deferred care.

As noted by the recent President’s Cancer Panel, colorectal cancer screening can effectively take place in the convenience of one’s own home with stool-based screening tests, such as the Fecal Immunochemical Tests (FIT). VA is implementing a program to deliver FIT screening to Veterans across the nation. This program will ensure Veterans have access to evidence-based screening in a timely manner, and this intervention has been shown to both reduce cancer mortality and improve health equity. National program guidance is being developed and pilot programs are underway with the goal of deployment in early 2023. It is estimated that 1.2 million Veterans are eligible for FIT screening.

We will be encouraging lung cancer screenings to the estimated 900,000 Veterans who are at risk for developing lung cancer. Lung cancer screening – using annual computed tomography (CT) scans – substantially reduces the number of people who die from lung cancer. Unfortunately, of the 1- to 2-million eligible Veterans, less than 10% currently have received even one CT scan for lung cancer screening.

In 2021, VA established the National Center for Lung Cancer Screening to address this problem. Its mission is to increase systematic and equitable access to high-quality lung cancer screening processes. The Center will leverage VA’s learning health care system to sustainably increase access to evidence-based lung cancer screening processes that are effective, equitable, safe and efficient. With the help of the Center, VA is poised for rapid growth in enabling Veterans to access lung cancer screening and subsequently dramatically reduce the number who die from lung cancer.

The Center supports and advocates for Veterans by implementing patient-centered care processes for shared decision-making, smoking cessation interventions, and connecting patients at very high risk of having lung cancer to additional levels of care. It partners with VA facilities to provide data and policy advice to central leadership regarding lung cancer screening-related issues.